Introduction <p>Universal Health Coverage (UHC) aims to guarantee access to health services without financial risk for the entire population. Despite the efforts made in Cameroon, particularly in Souza, the enrolment rate remains low. This study aims to identify the socio-demographic factors, knowledge, and perceptions that influence the enrolment of residents in the UHC, in order to adapt health policies and strengthen equitable access to care.</p> Methodology <p>The study was carried out in the city of Souza over a six-month period, from March to August 2024, with data collected between May and July. A sample of 400 participants was selected, including residents aged 21 and over. A structured questionnaire, pre-tested for clarity, was administered during face-to-face interviews. The data were analysed using R Studio, conducting descriptive, bivariate, and multivariate analyses to identify factors associated with enrolment in the UHC.</p> Results <p>The results show that out of 400 inhabitants, only 7% (28 inhabitants) were enrolled at the UHC. The most common gender was male (51.25%), 34.5% were aged between 21 and 30, and 55.25% had a secondary education. The results of the multivariate analyses showed that having a university education [AOR = 2.01; 95% CI: 1.12–4.91; <i>p</i> = 0.04], having heard of universal health coverage [AOR = 18.99; 95% CI: 4.25–84.88; <i>p</i> = 0.04], and perceiving the cost of enrolment as low [AOR = 2.12; 95% CI: 1.45–6.19; <i>p</i> = 0.03] significantly increased the probability of enrolment in universal health coverage.</p> Conclusions <p>This study highlights significant barriers to UHC enrolment, including a lack of awareness and negative perceptions of costs. The results suggest that targeted communication efforts and awareness-raising initiatives are essential to improve enrolment. Strengthening education and information about the UHC could contribute to better access to healthcare and increased participation by residents.</p> Clinical trial number <p>Not applicable.</p>